Complications Of Epidural Steroid Injections Research Articles

Severe cerebrospinal fluid-cutaneous fistula treated by an epidural tetrastarch patch

Severe cerebrospinal fluid-cutaneous fistula treated by an epidural tetrastarch patch

Abstract #122: Secondary Adrenal Insufficiency: A Complication of Epidural Steroid Injection

Abstract #122: Secondary Adrenal Insufficiency: A Complication of Epidural Steroid Injection

Key safety considerations when administering epidural steroid injections.

Neurological and other complications of epidural steroid injections have been widely discussed in recent years. Consequently, the US FDA issued a warning about serious neurological events, some resulting in death, and consequently is requiring label changes. Neurological adverse events numbering 131, including 41 cases of arachnoiditis, have been identified by the FDA, and 700 cases of fungal meningitis following injection of contaminated steroids. A review of the literature reveals an overwhelming proportion of the complications are related to transforaminal epidural injections, with the majority of them to cervical transforaminal epidural injections. This perspective describes the prevalence of administering epidural injections, complications, pathoanatomy, mechanism of injury and various preventive strategies.

Safety of epidural steroid injection methods in the management of recurrent lumbar disc herniation: few comments.

Dear Editor, We were recently interested by an article published in the Asian Spinal Journal by Karamouzian et al. [1], entitled Comparison of two methods of epidural steroid injection in the treatment of recurrent lumbar disc The authors presented an intriguing investigation comparing the effectiveness of the different methods of epidural steroid injection (ESI) in patients with recurrent lumbar disc herniation, and reported similar outcomes of transforaminal and caudal steroid injection procedures in the treatment of lumbar disc herniation. Although caudal and transforminal steroid injections are the commonly performed techniques in the management of the pain of disc herniation, the results are unsatisfactory, given the certain unique risks carried by ESI procedures. To Karamouzian et al. discussion, we also note the risks and complications of ESIs in the spine, which is evident in the results discussed below. Some studies in the literature showed that ESIs is no better or even worse than a placebo. It is also observed that ESIs is often implicated in permanent and severe complications such as spinal cord infarction, infection, intravascular injections, injections into the spinal fluid, nerve damage, hemorrhages, paralysis, weakening the disc or leading to discitis and archnoiditis [2,3]. Moreover, transforminal steroid injection technique does not decrease the risk of known complications of interlaminar steroid injection procedure, including hematoma formation, subdural and dural punctures, and cauda-equina syndrome [4]. Also, Manchikanti et al. [5] in a prospective, non-randomized study of patients undergoing ESIs observed complications including intravascular injection, local bleeding, oozing, and local hematoma with profuse bleeding. Other reports [6,7] indicated that ESIs provided no additional improvements and no significant functional benefits or reduction in the need for surgery. As is obvious from the above discussion, although ESI approaches are commonly performed techniques in the management of the pain of disc herniation, complications and pitfalls of ESIs should be assessed to alter and add more consistency to the results.

Pneumorrhachis and Pneumocephalus with Severe Chest Pain Symptom: A Rare Complication of Epidural Steroid Injection

Dear Editor, Pneumorrhachis and pneumocephalus are unusual complications of inadvertent dural puncture. We present the case of pneumorrhachis and pneumocephalus in a patient with lumbar spinal stenosis who was performed epidural steroid injection by using loss of resistance technique to air. A 37-year-old man with the history of spinal stenosis, low back pain, bilateral leg pain, and neurogenic claudication was performed epidural steroid (80 mg metil prednisolone) injection in another pain clinic. He complained of severe chest pain and headache aproximately 1 hour after epidural injection in the recovery room. The anesthesiologist who attempt epidural steroid …

Long-Term Complications of Epidural Steroid Injections

Epidural steroid injections (ESI) are common pain-relief procedures performed throughout the world, yet there remains controversy regarding their long-term safety. On the basis of current literature, serious long-term complications are rare yet can have devastating results. Potential etiologies for long-term complications associated with ESI include infection, bleeding, endocrine effects, neurotoxicity, and neurologic injury. Despite the multitude of literature on ESI, there is still a lack of studies specifically addressing possible long-term complications. Further research is therefore warranted.

Spinal Epidural Hematoma Following Epidural Steroid Injection in a Patient Treated with Dabigatran: A Case Report.

Lumbar epidural steroid injections are commonly employed in the treatment of degenerative lumbar conditions. The procedure is generally accepted as safe, and few complications have been reported in the literature. An exceedingly rare complication of epidural steroid injection is a spinal epidural hematoma. Although millions of epidural steroid injections have been completed since 19601-3, to our knowledge, there have been no more than fifteen reported cases of epidural hematoma related to epidural steroid injections4-16. A review of these reports reveals that nearly all of the patients involved were taking anticoagulants near the time of injection. In October 2010, the U.S. Food and Drug Administration (FDA) approved the use of a novel anticoagulant called dabigatran (Pradaxa; Boehringer Ingelheim Pharmaceuticals, Ridgefield, Connecticut) for the prevention of stroke in patients with atrial fibrillation. In Europe and Canada, the drug also has been approved for the prevention of thromboembolism in patients undergoing total joint arthroplasty. Dabigatran has experienced a rapid increase in popularity in the orthopaedic community because it has several benefits over enoxaparin and warfarin. Unlike enoxaparin, dabigatran is administered orally. Unlike warfarin, dabigatran has minimal monitoring requirements and few drug-drug and drug-food interactions, and it becomes therapeutic within hours instead of days17. Currently, to the best of our knowledge, there are no known cases in the literature of dabigatran-associated complications after epidural steroid injections. Recent clinical trials involving over 20,000 patients treated with dabigatran did not identify a single case of spinal epidural hematoma17,18. The patient was informed that data concerning the case would be submitted for publicaton, and he provided consent. ### History A seventy-year-old man presented with ongoing symptoms of lower back pain and bilateral leg pain for four months. Neurological examination revealed full motor strength in the …

Epidural steroid injections in the management of low-back pain with radiculopathy: an update of their efficacy and safety.

Epidural steroid injections (ESIs) have been widely used for over 50 years in the treatment of low-back pain with radiculopathy. Most interventional pain physicians strongly believe in their efficacy and safety. Recent Cochrane systematic reviews have disclosed controversial results and have questioned the effectiveness of ESIs. Moreover, a few neurological adverse events have been reported recently. A literature search of systematic reviews analysing the effectiveness and complications of ESIs was carried out. The scientific quality of the reviews was assessed using the validated index of Oxman and Guyatt. We relied on data abstraction and quality ratings of the placebo-controlled trials as reported by high-quality systematic reviews. Two types of systematic reviews were found. The Cochrane high-quality systematic reviews combining the three approaches and different pathologies were predominantly non-conclusive. The second type of review, emanating from the US Evidence-based Practice Centers, distinguishing between the routes of administration and between the principal pathologies found a moderate short-term benefit of ESIs versus placebo in patients with disc herniation and radiculitis, in keeping with the clinical experience. ESIs are generally well tolerated and most complications are related to technical problems. Cases of paraplegia, complicating the foraminal route and related to the violation of a radiculomedullary artery, have been recently reported. They are predominantly observed in previously operated patients. Epidural steroid injections have a moderate short-term effect in the management of low-back pain with radiculopathy. Severe neurological complications are exceptional, but call for research for alternative approaches to the foramen as well as for means to detect an eventual arterial injury.

Epidural steroid injections: Complications and management

Epidural steroid injections (ESIs) are a form of interventional therapy broadly used worldwide for the treatment of pain. Although generally considered a safe treatment, with a low incidence of complications, these may range from very mild and transient symptoms to truly catastrophic events, including brain damage, spinal cord injury and death. Even when proper technique is used, sufficient training in interventional pain medicine is obtained, and adequate safety measures are taken, fatal events can occur. The purpose of this review article is to examine the reported complications of ESIs and suggested negative outcome management.

JCAHO Tweaks Emergency Departments’ Pneumonia Treatment Standards

Orthopedic Surgeons as treatments that are reasonable and efficacious. Future studies of epidural steroid injections for low back pain compared with other therapies should more accurately determine the degree and duration of pain relief andwhichpatients experienceclinically meaningful responses, the authors wrote. More information also is needed on the number of treatments required and when they should be administered, as well as whether adverse events are of concern. Reported complications of epidural steroid injections are usually minor and transient, but rare major complications—including aseptic meningitis, bacterial meningitis, and epidural abscess—may result from improperly performed injections. There may be underreporting of complications, particularly from less experienced practitioners, said Armon. The authors also looked for studies on the use of epidural steroid injections to treat radicular cervical (neck) pain, but because these studies failed to meet the authors’ inclusion criteria, the academy could not make any recommendations at this time.